Digital Media and Suicidality in American YouthBy: Nicole E. Spears

Many of us remain hesitant to talk openly about suicide. While it can certainly be uncomfortable to confront a loved one with questions about their mental health, research tells us that these difficult conversations are a fear worth facing.

Stigma surrounding suicide is more harmful than you might believe. Data from the Centers for Disease Control and Prevention (CDC) show that suicide is the second leading cause of death among Americans ages 10-34. The coupled effects of the increase in death by suicide and the opioid crisis have resulted in a drop in U.S. life expectancy for the second time in three years.

"Life expectancy gives us a snapshot of the Nation's overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable."

"We're seeing the drop in life expectancy not because we're hitting a cap [for lifespans of] people in their 80s. We're seeing a drop in life expectancy because people are dying in their 20s [and] 30s."

As rates of American deaths by suicide have crept up over recent years, new digital tools and social networks have introduced both challenges and opportunities. There is a lot we have yet to learn, but we are learning more about the ways that children's virtual experiences are impacting their mental and physical wellbeing.

What is digital media's impact on mental health?

We can be certain that our screens are impacting our health, behavior and happiness. But, how so? Emerging media–spanning Facebook to Facetime–have offered benefits like connectivity despite geography, improved (yet imperfect) access to information and new avenues for fundraising. We've seen benefits specific to mental health as well, like the enhanced ability to access mental health counseling through virtual talk therapy apps such as BetterHelp.

In an informal survey of roughly 50 U.S. based Instagram users, it was reported that:

40% of respondents report feeling uncomfortable confronting a loved one they feel is at-risk for suicide

30% of respondents would prefer to confront a loved one that they feel is at-risk for suicide via text, FaceTime, social media or another digital platform versus face-to-face

50% of respondents have used the internet to access resources to help themselves or a loved one through suicidal ideation

danah boyd presents her research on the social lives of networked teens in the 2014 book, It's Complicated.

These unhealthy impacts of digital media are a research interest of Dr. Jean Twenge, a Professor of Psychology at San Diego State University. In a 2017 Atlantic article "Have Smartphones Destroyed a Generation?" Twenge states:

“Rates of teen depression and suicide have skyrocketed since 2011. It’s not an exaggeration to describe iGen [those born between 1995 and 2012] as being on the brink of the worst mental-health crisis in decades.”

However, it is important to resist drawing a binary conclusion from findings that link a spike in youth deaths by suicide to smartphones. We are not learning that digital media is simply bad for our health. But, we are learning that, along with the new behaviors that digital media has introduced in our lives, new boundaries are also necessary.

This is demonstrated well in new guidelines released by the World Health Organization: To grow up healthy, children need to sit less and play more. This report, which recommends limited screen time for children fives years of age and younger, reminds us that correlation does not equal causation.

World Health Organization "Recommendations at a Glance"

In summary, these guidelines recommend establishing patterns of balance between physical activity and sedentary time. We know that screen time and physical activity are generally contradictory, and that the blue light of our smartphones is harmful to our natural circadian rhythm. These reminders suggest that the relationships between the digital media we use and the mental wellbeing we enjoy are 1) more complicated than they seem at face value and 2) established at a young age.

Can digital media help us prevent youth suicides?

Social media's potential for harm is the subject of much more conjecture than its potential for good. But digital tools aimed at addressing and improving mental illness, such as Crisis Text Line (CTL) and e-Counseling apps, are growing in popularity. As the challenges of our growing digital culture present themselves, so too do new avenues for progress.

CTL data has revealed that more than one third of their texters who write in with concerns of depression or self-harm also reveal suicidal ideations. It's data like this that makes the platform so powerful in the quest to understand and treat mental illness in teens. According to CTL's mission statement:

"Crisis Text Line was built from the ground up around technology and data. Ultimately, our goal is to use data to improve outcomes for people in crisis."

To fulfill this goal, CTL hosts open data collaborations publishes their own analyses through CrisisTrends.org. This data can be used to support more impactful research, policy and community organizing.

For a more widely known example, take Instagram's Suicide Prevention feature that was introduced in 2016, allowing users to flag content that led them to worry about the poster's wellbeing.

The feature is powerful and unique in its reliance upon the network to self-regulate. It also represents a noteworthy break from the ever-present algorithm. According to a CNN article "Instagram launches suicide prevention tool":

"The flagged posts will be reviewed by a team of people who are working 24/7, and will not rely on algorithms to judge whether someone is vulnerable."

Aforementioned e-Counseling apps, like BetterHelp and Talkspace, also leverage established digital behaviors and broad networks to provide virtual talk therapy to patients through their mobile devices. In early 2018, BetterHelp partnered with Instagram illustrator and influencer @IntrovertDoodles to promote their services to her network. From the service they provide to the recruitment of their patients, e-Counseling apps represent a fully-digital health care experience.

Lastly, there are early indicators that the stigma surrounding suicide and mental illness may be lifting, and you will witness them if you spend enough time on Instagram's "Explore" tab. Memes about suicide and mental illness are increasingly common here, also on 9gag and Tumblr. Rather than viewing these (often extremely dark) jokes as threatening, some experts in suicidology see a benefit in the trend.

"Memes about suicide remain largely uncharted territory. While disturbing, they’re far less graphic than actual depictions. And they’re often darkly funny. As the gatekeepers of social media are wrestling with how to police this trend, some suicide-prevention experts see a window of opportunity. Typically, suicide memers aren’t mocking suicidal thoughts; they’re commiserating and bonding over being suicidal. Morbid memes, these experts believe, may be a foot in the door to one of the most vulnerable and hard-to-reach populations: socially isolated young people."

The trend of opening up about health questions and concerns online is not new, and is not exclusive to the younger generations. Analysis of the data we are creating, however, is a relatively novel concept. For example, a team of Microsoft researches have developed a model that could analyze tweet content and quantity to determine whether a user is at-risk for suicide. So, while our screens offer us anonymity that was previously inaccessible to most, that anonymity has encouraged extreme vulnerability as well.

"Some observers may think it is odd, but this online sharing could be the modern version of an age-old instinct to seek solace among peers."

So, yes, digital media is being used to help us prevent youth suicides in both quantifiable and inestimable ways. To build on this momentum and use social networks, smartphones and other digital tools to make a meaningful impact on at-risk youth, it is vital that we understand and adopt evidence-based approaches to suicide prevention.

WHO ARE THE DIGITAL CHANGE-MAKERS?

The most impactful positive influence available to an at-risk youth on social networks are their peers. There are many benefits of peer-to-peer support in combatting suicidal action. Evidence from Zero Suicides suggests that this approach "promotes crucial protective factors such as connectedness and hope" and "promotes choice and voice in treatment."

Digital communities and campaigns uniting those struggling with depression and suicidal ideation have had success using these channels to raise funds and awareness to support treatment and prevention. A few leaders in the space include:

To Write Love on Her Arms, also known as TWLOHA, is a nonprofit that raises awareness and funds for those struggling with depression, addiction, self-harm and thoughts of suicide. The organization was founded by Jamie Tworkowski, author of If You Feel Too Much and outspoken mental health advocate.

The organization has built a platform for artists to share their messages of hope and inspiration through social networks like Twitter and Instagram. Most recently, TWLOHA raised more than $85,000 for the cause through a virtual 5k.

Why We Rise, an ongoing project of the Los Angeles County Department of Mental Health, addressed local youth with suicide prevention messaging that took focus on issues of access, criminalization and stigmatization. This last issue, the stigma of mental health, is a key concern for at-risk youth where the intersection of cyber-bullying and self-identity complicate matters.

On Our Sleeves is a mental health initiative to transform children’s mental and behavioral health put on by Nationwide Children’s Hospital headquartered in Columbus, OH.

As a leader in both the care and research of children’s mental health conditions, Nationwide is well-positioned to launch this initiative that leverages digital platforms to share resources for teachers and administrators, host a behavioral health webinar series and medical resources like prescribing guidelines.

Digital media presents known challenges to the health and wellbeing of American youth. But, we've also seen artists, change-makers and physicians use digital tools to care for those in crisis in ways we couldn't have imagined only years ago. Suicide is preventable, and there is an optimistic future ahead for those who are willing to have hard conversations in innovative fashions.

"But in the end, as people use the things we create for harm, there will be a lot more instances when they are used for good. And, most important, when they make us all feel a little more connected, and a little less alone." -Nick Bilton

If you or a loved one is experiencing a crisis, text "home" to 741741 for free and anonymous care, available to everyone 24/7.